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  • Title: [Regression of hard exudates in diabetic background retinopathy in therapy with etofibrate antilipemic agent].
    Author: Freyberger H, Schifferdecker E, Schatz H.
    Journal: Med Klin (Munich); 1994 Nov 15; 89(11):594-7, 633. PubMed ID: 7815987.
    Abstract:
    BACKGROUND: The aim of this pilot study was to investigate the influence of a lipid lowering therapy with etofibrate on the progression of diabetic background retinopathy in patients with diabetes mellitus and combined hyperlipoproteinemia. In addition to the well known correlation between the duration of diabetes and the quality of blood glucose control, a correlation between diabetic microangiopathy and elevated triglyceride levels is discussed for many years. The most important pathogenic mechanisms in this respect seem to be an elevation of blood viscosity and alterations in the fibrinolytic system. Fibrinogen and triglycerides are the main determinants of plasma viscosity. As lipid lowering drugs containing fibrates and nicotinic acid are able to lower triglycerides and fibrinogen effectively, a favourable therapeutic effect on the progression of diabetic retinopathy may be expected. PATIENTS AND METHOD: 11 type II diabetics with combined hyperlipoproteinemia (Fredrickson type IIb) and mild to moderate background retinopathy detected by fundus photography were treated with etofibrate (2 x 500 mg/day) for a period of 6 months. RESULTS: In 7 of 10 patients hard exudates, which had been present at the beginning of treatment, showed clear regression at the end of the treatment period. Among the laboratory test parameters a significant 30% reduction of triglycerides (p < 0.010) was observed. There was also a clear 25% increase in HDL cholesterol and a 12% fibrinogen reduction. Considerable changes of the quality of blood glucose control were not evident during the treatment period. CONCLUSION: Treatment with the lipid lowering drug etofibrate seems to produce favourable therapeutic effects on hard exudates in diabetic background retinopathy in patients with diabetes mellitus and combined hyperlipoproteinemia. The mechanisms of this effect are not yet clearly understood, in addition to positive effects on the microcirculation of the retina by lowering blood viscosity there is a direct lipolytic effect in the area of hard exudates to be discussed, too. It is important to point out that we did not see any positive effect of etofibrate therapy concerning other morphological changes of diabetic background retinopathy, i.e. microaneurysms or hemorrhages in our pilot study.
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